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Skin Cancer and Malignant Melanoma
Skin melanoma: statistical data in Ukraine
19,3 % - death within a year,
M. – 26,2 %; F. – 14,9 %
49,7 % - 5-year survival
67,7 % - І-ІІ stages
Comparative Statistics: UA – USA
Ukraine USA
5-year survival
49,7 % 88,0 %
Melanoma in situ
0 37,5 %
Year: 2000 2000
Biologic progression of melanoma
Melanocyte → nevus → dysplastic nevus → меlanoма “ in situ” → superficial spreading melanoma →
nodular melanoma → metastatic melanoma
Sponsored
Medical Lecture Notes – All Subjects
USMLE Exam (America) – Practice
Malignant Melanoma: Risk Factors
Age > 40 yr. Race: whiteSun exposure: UVA, UVB Hereditary factors: “melanoma families“, atypical mole syndrome or dysplastic nevus syndrome Trauma of moles, Giant congenital neviOncogene mutations
Screening:
Self-Examination for Melanoma:
examine your body front and back in the mirror, arms and palms, legs and feet, neck and scalp – If you have any doubt about a mole, see a dermatologist-oncologist
(American Academy of Dermatology)
Professional education:
students family doctors dermatologists surgeons cosmetologists morphologists oncologists ! nurses
ABCD-test
ABCD rules for diagnosis of melanoma:
Epiluminescence microscopy (dermatoscopy)
Epiluminescence microscopy (ABCD)
ЕЛМ
Diagnostics system MoleMax:
Growth patterns of melanoma:
superficial spreading melanoma – 70% nodular melanoma – 15-20% lentigo maligna melanoma – 4 -10% acral lentigo-melanoma – 2-8% amelanotic melanoma – 5%
Thickness of melanoma
TNM:
T1 < 1 mmT2 1-2 mmT3 2-4 mmT4 > 4 mm
Radial growth phase
Vertical growth phase
Evaluation for Metastasis: N0-3, M0-1
Regional Lymph Nodes: N0 – no metastasis,N1 – one lymph node with metastasis,N2 – 2-3 lymph nodes with Mts.,
N3 – 4 and > metastatic lymph nodes. Distant Metastasis: M0 – no metastasis,M1a: Mts in subcutaneous tissue, M1b: Mts in lung,M1c: Mts in other visceral organs (brain, liver, etc)
Nodular Melanoma Т4bNхM0
Biopsy techniques
For cytologic diagnosis:- fine-needle aspiration,- superficial scraping.
For histologic diagnosis:- complete excision
(Clark’ levels,Breslow’s thickness)
melanoma
operation
Sentinel node biopsy,or regional lymph node
dissection
Regional lymphangiectomy
Surgical approach to lymphogenous metastases of melanoma
Complex treatment of primary melanoma Т3bN1аМ0(X-ray + Chemo. → Surgery + Chemo. + INF)
Operative wound closed by flaps’ transposition
Lentigo maligna melanoma (arise from Hutchinson’s freckle)
1 year after Radiation Therapy
Melanoma: scars, recurrence, in transit Mts
1
3
2
4
Superficial melanoma with skin lymphangeitis and in-transit metastasis
Wound xenoplasty after wide local excision of melanoma
Skin autografting of granulated wound
Spleen metastasis of melanoma (2001);CT scan in 3 years after splenectomy (2004)
04. 2001 06. 2004
Меланома: метастази в селезінку і лімфовузли
Хворий К., 34 роки03.2000 – меланома шкіри на
спині, T3bN0M0Лікування: - БФ-РТ, СВД 80 Гр,- Операція - ПХТ + лаферон (2 курси)04.2001 – метастази в л/вузли
і селезінку04.2001
Melanoma metastases into spleen (surgical specimen) and lymph node
“In transit” metastases
Metastatic melanoma
Palliative γ - therapyHormonotherapySupportive care
Skin cancer
Basal Cell Carcinoma, T1N0M0
(growth pattern)
Precancerous diseases:
Факультативні:
- гіперкератози,- шкірний ріг,- папіломи, - фіброми,- гемангіоми,- бородавки
Облігатні:
пігментна ксеродерма, хвороба Боуена, еритроплазія Кейра
Skin cancer
Basal Cell Carcinoma, T1N0M0
(ulcer pattern)
Skin cancer
Squamous Cell Carcinoma,
T4N0M0
TNM-Classification of Skin Cancer:
Тis – carcinoma in situ Т1 – ≤ 2 cm Т2 – 2 - 5 cm Т3 – > 5 см Т4 – t-r invades cartilage, muscle, or bone. N0, N1 M0, M1
Skin Cancer
Squamous Cell Carcinoma of lower eyelid with invasion in bulbar conjunctiva,
T4N0M0
Skin Cancer
Squamous Cell Carcinoma of Cheek,
T4N0M0
results of local phytotherapy for a year!!!
Skin Cancer
Results after half course of gamma-therapy, 45 Gy
Skin Squamous Cell Cancer of Neck:
Postoperative wound is temporary covered with Pig skin xenografts
Skin Cancer:granulation wound (1), skin autografting (2)
Wound after removing of xenografts
Skin Cancer: complete recovery12 months later
Тернопільське озеро
Дякую за увагу!